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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED OPERATOR FACILITY EMPLOYEE TRAINING RECORD For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Anthority Cited: Title 23,Div. 3, Clt. 16 California Code of Regulations(CCR) Facility Name: -- Facility Site Address: �/,lGfo� .-_ - _— city: � - Section 2715 of Title 23, California Code of Regulations, requires that Designated Underground Storage Tank Operators provide training to facility employees who have responsibilities associated with the operation and/or maintenance of underground storage tank(UST)systems.This training must be provided by July 1,2005,and every 12 months thereafter. For facility employees lured after July 1,2005,the initial training must he provided within 30 days of the date of hire. At least one of the facility employees present during operating hours must have current training.This training must include,but is not limited to,the following items as specified in 23 CCR Sections 2715(f)(1)and(2): 0 Operation of the UST system in a manner consistent with the facility's Best Management Practices; ❑ The employee's role with regard to UST monitoring equipment as specified in the written LIST Monitoring flan; ❑ The employee's role with regard to spills and overfills as specified in the written UST Response Pian; 0 Names)of contact person(s)for emergencies and monitoring equipment alarms; ❑ For facilities that are not routinely staffed,facility employee responsibilities as specified in the training program approved by the local USS regulatory agency. 23 CCR§2715(t)(3)requires that a list of employees who have been trained by the Designated Underground Storage Tank Operator(s)be maintained on-site,or off-site at a readily-available location if approved by the local afrency,and provided to the local agency upon request.Completion of this form will satisfy UST training record keeping requirements.The following employees have been trained as required by 23 CCR Sections 2715(f)(1)and(2): Facility Em loyec Name Trainin Date} Hire Date' Trainer Name' 10-X 17 4 \� 1 Y1 G 10 — •` �-- P ' !o -4-17 ''t�G-t"'''`''"' (Continued on reverse) if hired after July 1;2005. 'Trainer must be a current Desigmted UST Oicraior for the facility w the tune of training. liN4)6I-112 www.uuidor arg Q7/}3101 ��osl3gas